Top 5 Healthcare Fraud Schemes

fraud investigation files

Medical providers are supposed to work hard to improve their patients’ lives, but that isn’t always the case. Unfortunately, some have tried to illegally profit through schemes and fraud. These are the top 5 healthcare fraud schemes deceptive companies use on victims. 

1. Getting a Real Bill for Fake Services

One of the most common fraud schemes is billing an individual for services they never received. The bill clearly states you had specific tests, procedures, or even just checkups on specific dates despite the fact that you never did. 

To fight this one, you need to keep track of everything you have done from the doctors to the dentists and more. These offices won’t have records to backup the healthcare company’s claim, making it easily proven invalid and allowing you to pursue legal action. 

2. Faking Dates

There are providers who stand to earn mote money if they report that a patient was visited and treated on two separate days instead of one. Since each office visit is billable, criminals simply claim there’s more of them. Ask these NYC federal crimes defense attorneys, it’s been tried by plenty of fraudulent companies. 

3. Waiving Deductibles and Co-Payments

This tactic is a sly one. By waiving deductibles and co-payments, the person visiting the healthcare clinic or professional seems to be saving money. What happens next is that the hospital or clinic submits a false claim to earn the money anyway, sometimes more. 

In the long run, this short-term savings ends up costing a lot. Insurance companies then compensate for the extra expenses by increasing premiums, which means individuals now have to pay more for their coverage. 

4. Incorrect Diagnoses and Procedures

Similar to how auto repair shops have been caught charging customers for services they didn’t provide, like billing for a tune-up when all they did was change an air filter, this healthcare fraud relies on false reporting. 

By reporting a serious diagnosis or saying they performed a procedure that never happened, providers can charge for those services and line their pockets. The possibilities are near-endless with this scheme as it’s an easy way to cheat the system. Say someone fell in a nursing home but was fine other than bruises, for instance, a provider could diagnose head trauma and charge for a CT scan that never happened. 

5. The Prescription Drug Racket

Like many schemes on this list, part of the prescription drug racket is charging insurance companies for drugs a physician never prescribed. The other, more sinister end to this scheme is supplying drugs to patients who simply do not need them. 

Painkillers, a highly abused category of prescription medication whose opioid variant contributes to the opioid crisis, are a common tactic. This scheme can come from many ends, as well. It could be patients visiting multiple doctors to obtain the drugs, then selling them on the street. It could also be employees taking advantage of the access they have. 

Finally, it could be doctors unnecessarily providing drugs to patients who don’t need them in order to make more money. Regardless of the fraudulent scheme at hand, fraudsters will need the help of a Federal Criminal Defense Lawyer in DC one they are caught.